I was diagnosed with a 8-cm fibroid only today (13 Jan), after doing an ultrasound, and my gynecologist whom I was seeing for the first time, has scheduled my surgery to be done 13 days later without telling me much about the surgery.

Is this too rushed? Do I need to consult another Doctor before deciding on the surgery?  I found out from the staff of the hospital which my gynecologist is working at that she has 8 years of experience and has just been promoted to have her own clinic in the hospital. So, I feel a bit uneasy.

Please kindly advise.

M.

M.

Yes, you need more explanation from the doctor. First of all, the fibroid may not need to be removed at all unless you are having bothersome symptoms. Second, most of the time an 8 cm fibroid can be removed laparoscopically in the hands of an experienced surgeon. See this page: http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

Laparoscopic myomectomy has the advantage of outpatient surgery and a fast recovery. I always think a second opinion is a good idea if you are recommended to have surgery.

Bill Parker, MD

Hi Dr. Parker,

Thank you so much for your website.  It is quite informative.  I have 3 very large fibroids on the left side of my uterus.  One in particular is causing a great deal of pain.  My Dr. said it was dying so it has to be removed.    I had a myomectomy about 11 years ago, so this will be my second.  I still do not have children and would like to at some point.  Is it safe to perform another myomectomy?  Will this leave my uterus with too many scars?

Have you performed more than one myomectomy on the same patient?  If so, were they successful in becoming pregnant and carrying a baby?  Any information about a 2nd myomectomy would be greatly appreciated.

Thank you. W

W,

In the hands of a skilled surgeon, a second myomectomy is likely to be successful.  Yes, I have had to do this and yes, it was fine. With good surgical technique, the scars on the uterus heal very well and should withstand the stretching that occurs with pregnancy. If the incisions in the uterus go all the way into the uterine cavity, we often recommend that you have a Cesarean section so the scars do not have to withstand the forces of labor.

Also, I use an adhesion barrier called Seprafilm to help prevent scar tissue around the outside of uterus, tubes and ovaries, so you might ask your gynecologist about this.

Bill Parker, MD

For more about abdominal myomectomy see:http://www.fibroidsecondopinion.com/abdominal-myomectomy/

Hello Dr. Parker,

I was doing some research online and came across your website and looking at Laparoscopic and Robotic Myomectomy. But I have few questions for you, hope you would be able to answer it for me.

I am 27 years old and found out about the Fibroid when I just turned 26. The nurse, doctors, radiologist, everyone were surprised that for a young person like me has Fibroids.  And I do not have a family history of Fibroids either. Since, then I have been doing Ultrasound and regular checkup every 6 month with my doctor.  I have 2 big fibroids, one on the top of the Uterus and another behind or on the wall of the Uterus.  Since I am so young, there are so many complications, I have to think before choosing the Option.

Last week, my doctor told me, both fibroid have grown to the size of not quite as Soft ball but larger than BaseBall. And recommended I have the Laporoscopy Myomectomy done, as soon as I can.  Since, the bigger, it gets, harder and complicate for surgery.   This week, I went for second opinion and the doctor recommended/told me da Vinci myomectomy. I read a lot about it online too. But I am really confused now and scared too because I have never had any surgery before. Both has its advantage and disadvantages, I was wondering if you have suggestion for me. I called my regular doctor and told about da Vinci Myomectomy, she told me I am not the candidate for that since my fibroids are big. I have the surgery date scheduled in few weeks, I am getting more and more scared and worried, as to what I should do. What would be the good decision for me, since I plan on getting pregnant in the next few years when I am married?

I appreciate your time and opinion. Hope to get a reply from you.
Thanks,
A.

A,

Is the first doctor recommending a laparoscopic myomectomy (telescope through the navel) or an abdominal myomectomy (bikini incision)?   Laparoscopic myomectomy and robotic myomectomy are very similar and both have a faster recovery than abdominal myomectomy. It sounds like your doctor does not perform either laparoscopic or robotic myomectomy and is nervous about the size of the fibroids. The important thing with either of these procedures is to find a gynecologist who has a lot of experience and skill doing the procedure.

Bill Parker, MD

Thank you for the reply.   My regular doctor does the laparoscopic myomectomy. Because my fibroids are big, she can’t do the laparoscopic myomectomy. She said she has done many myomectomies, however I should ask more questions.

The procedure she will be performing on me is “myomectomy per Laparotomy” which is the abdominal myomectomy. I think I am going to do more research. And also waiting to find out, how often my doctor performs this procedures and complication, successes etc. I think she already has given answers to a part of these questions.

Thanks,  A.

A.

You should also ask the other doctor how many da Vinci (robotic) myomectomies they have done, how many for women with fibroids the size of yours, how many have gotten pregnant, how many complications they have had.  This is a relatively new procedure and some doctors are just learning.  You do not want them practicing on you!

Bill Parker, MD

For more information about laparoscopic and robotic myomectomy please see:

http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

Although serious problems are less of a risk for young, healthy women who are having myomectomies (you are all really young and healthy compared to 80 year-olds in an ICU!), the best strategy is getting your blood counts up before surgery and using a cell-saver during surgery.

For women with very low hemoglobin levels (below 9), I usually use Procrit to stimulate red blood cell production for about 3 weeks before surgery. High doses of iron must also be given, so your body has the building blocks to make red blood cells, and vitamin C is also given to help you absorb more iron through the intestines. There is no magic number, but it is nice to have the hemoglobin 10 or higher before surgery, unless heavy menstrual bleeding does not allow us to get the blood counts up even with Procrit and Vitamin C (very rare).

The second strategy is the use of the cell saver, which allows us to replace blood loss, if necessary, immediately during surgery with the patient’s own blood, before it has a chance to deteriorate. Also, there is no risk of HIV, hepatitis or mismatched blood with the cell-saver.

Blood is suctioned from the incision and operative area, stored in the canister, and then filtered and returned to the patient through an IV

And lastly, the current recommendation is to not transfuse blood unless the patient is very dizzy when they stand up or very weak, or until the hemoglobin is below 7 (it used to be below 10). Since the blood doesn’t work very well anyway, it is better and safer to allow the patient to build up her own blood slowly during the recovery period.

There is a push to explain all this new information to doctors because it is different from what we were all taught. So, you will find differences of opinion based on a doctor’s knowledge of this new information.

More about myomectomy surgery can be found at this link: http://www.fibroidsecondopinion.com/abdominal-myomectomy/